Grievance Debate

Health Review

Dr McFETRIDGE (Morphett) (17:43): Tempted as I am to respond to the Minister for Emergency Services' remarks, I will save that for another day. Considering what the Minister for Health said today in this place, I am just going to enlighten him on some of the effects of his so-called Transforming Health, by referring to an email that was sent to me during question time by somebody who I have personal knowledge of and who has vast experience in the South Australian health system. In particular, in this case, they are talking about the Noarlunga health system, and I read from the email:

I am writing this to express some very deep concerns re the closing of Noarlunga ED, and the negative impact this will have on the Southern Area, and also the functioning of [the Flinders Medical Centre]. There are many concerns (of which I will point out a few only)—

I am reading the email here, so I will read it as it is written—

and I feel that Jack Snelling and his department have only a very simplistic view of just what Noarlunga ED does, and are unaware of how much of a contribution Noarlunga makes to the health of the surrounding area, and indeed to the whole of the Fleurieu Peninsula (which is our current catchment area).

Historically, the proposed changes are just a step backwards in time, going back to Noarlunga EDs first origins—which was as a walk-in 'Drop In Centre'. As the area grew, so did the health needs of the area, and the centre evolved into a fully-fledged ED (with a beautiful, still new, purpose built ED which is remarked on by all who visit from other ED Depts to be the nicest in the state). It seems very strange that, as the Southern Area continues to expand massively, with huge new housing developments being built constantly, an ED treating 50,000 people a year is no longer needed…Even stranger given that we are all aware that FMC is not, and cannot cope (and nothing in the Transforming Health proposals looks to be going to change this)…FMC diverts Ambulances on a virtual daily basis to Noarlunga because of their failure to cope.

When Jack Snelling states that Noarlunga only needs to be a walk-in ED, because we discharge 87% of our patients, he shows absolutely no understanding whatsoever of the type of patients we are treating. We constantly take major pressure from FMC's Emergency Department. A huge number of those 87% of patients that Jack and his advisers have so casually dismissed, will not be able to be treated at a walk-in centre; If Noarlunga ED closes more than 20,000 extra patients a year will present to the Flinders ED. Flinders will not be able to cope with that load, as they are not coping with their current load. I am sure FMC staff are contacting you as I write this, to say that very same thing.

I give you some examples (a very tiny selection of the vast array of complex problems that we assess, treat, and are able to discharge—a lot of the time because we have learned to do it better—something we are about to pay for unfortunately).

1. Patients with renal colic and biliary colic—they present in agony, vomiting, require IV medications immediately, IV fluids, multiple tests, and observation for some hours. We then discharge them.

2. Patients who collapse or have a seizure—they require ECG, extensive history and examination, multiple tests and extended period of observation. We then discharge them.

3. Patients who present with bleeding or pain in pregnancy. We do extensive work, observation and consultation with FMC. For the most part we then discharge them.

4. Patients with chest pain present constantly to Noarlunga (approx 9 out of 10 people presenting with chest pain will have a non cardiac cause, but thoroughly ascertaining this, and the patient's safety to discharge, takes several hours). We then discharge them with a referral to a 'Low Risk Chest Pain Pathway' or to…their GP—if they meet carefully considered guidelines that have been set out by Cardiologists at FMC. Those patients who present with a definite heart attack (confirmed to be so at Noarlunga with an immediate ECG on arrival) are sent within a few minutes to FMC (as a 'CODE STEMI'); at FMC a theatre is prepped and awaiting them.

5. Patients with transient neurological symptoms (i.e. a few minutes of face or arm numbness which could be a sign of a Transient Ischaemic Attack…which is a stroke warning) also have an extensive workup at Noarlunga, before those deemed to be safe to discharge (via following a well developed FMC 'TIA pathway'), we then discharge, with followup planned by GP, neurology outpatients, or to an early TIA pathway review. Those who have signs of a stroke fitting certain criteria, are sent within a few minutes to FMC under a 'CODE STROKE' pathway, where definitive treatment awaits. The former group that can be safely discharged vastly outweigh the latter group that are needing admission.

Both examples 4 and 5 only occur when patients walk in, as ambulances already bypass Noarlunga if it is clear that a patient is indeed having a heart attack or stroke. These patients, and many others, with every possible emergency imaginable, are still going to walk in to a Walk in ED. When they do…we will only have limited facilities and staff to treat them (or does Mr Snelling think we are going to turn them away at the door and make them either wait on the footpath for an ambulance, or drive on/catch a bus…to the FMC). Because we will always have a duty of care to all patients, we will still be seeing and instituting emergency care—as much as we are rendered capable of.